Ovarian Cancer: A Step Toward Better Treatment for a Deadly Disease

By Erin Hicks, Everyday Health Staff Writer

Researchers at Yale call ovarian cancer a "public health crisis" and are looking for better ways to treat this killer of women. They're hoping to get at the root of the environment that encourages development of ovarian cancers and the stem cells that nurture its growth.

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MONDAY, Jan. 7, 2013 — New research about ovarian cancer aims to find better ways to screen for and treat the disease that some doctors are calling a “public health crisis.”

“Ovarian cancer is an understudied area,” says Nita J. Maihle, M.D., PhD, professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale. “It has a low incidence, but high mortality rate for women.”

Maihle says the typical age range for women who are diagnosed with ovarian cancer is late fifties to early sixties.

According to the U.S. Centers for Disease Control and Prevention, 21,204 U.S. women were diagnosed with ovarian cancer in 2008 (the most recent data available), and 14,362 women died from the disease that year.

There aren’t any imaging or blood tests to screen for ovarian cancer, so women usually have to wait until they experience symptoms before it’s diagnosed. By that time, the cancer has usually progressed and spread, making it very difficult to treat.

“We don’t have the equivalent to a pap smear for ovarian cancer,” says Maihle.

Combining Two Research Approaches to Find a New Treatment

Researchers at the Yale School of Medicine, including Maihle, recently published an analysis in which they connect two concepts that could help scientists develop novel targeted ovarian cancer therapies to better get at the root of tumor growth.

“The field of cancer therapies has been revolutionized by personalized medicine where we can identify specific markers on tumor cells and go in with silver bullets to much more efficiently kill the tumor cells without killing all the healthy, rapidly dividing cells,” says Maihle. “We don’t currently have good, biologically targeted therapies for ovarian cancers like we do for other cancers, like breast cancer.”

The Yale study, published online in Cell Cycle, backed up the “cancer stem cell” idea that at the heart of every tumor, a small subset of the original tumor cells fuel its growth. The second concept defines a critical role for the tumor cells’ micro-environment — the cells and biochemical cues in the area around the tumor that allow cancer cells to grow and spread.

“We’ve linked the stem cell factor and the micro-environment and shown how critical both are in allowing the tumor cells to survive and grow,” says Maihle. “The new thinking is that we’ve been treating the bulk tumor population, leaving behind a rich environment for the tumor stem cell population to grow.”

Why Ovarian Cancer Is Hard to Diagnose

The signs of ovarian cancer can be very general and easy to misdiagnose or completely overlook. Symptoms include feeling bloated, constipated, or having diarrhea, or a general feeling of malaise that can’t be associated with any specific region of the body. Sometimes women may feel abdominal pain but not always, according to Maihle.

The combination of the generalized nature of ovarian cancer symptoms and the lack of screening accounts for why the majority of women who are diagnosed with ovarian cancer are found to have it in late stages.

Ovarian Cancer and Future Treatments

Maihle says the tumor stem cell idea and micro-environment are concepts that have been dormant for a while, but are reemerging with new data. “Putting together two key emerging concepts in cancer biology research should make new targets for the development of new therapies more obvious and effective," she says. "We haven’t been targeting stem cells in the treatment of ovarian cancer, and it’s becoming obvious it’s critical to do that.”

But even if better targeted therapies are developed, it’s only half of the equation. If doctors are able to identify the disease and diagnose it in women in stages 1 or stage 2, it has a much higher cure rate.

“It will take a combination of approaches including improvements in early detection, as well as the development of improved biologically targeted therapies to truly impact this disease as a public health problem,” Maihle says.

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